Efikasi repetitive transcranial magnetic stimulation sebagai terapi epilepsi refrakter
https://doi.org/10.22146/bns.v19i2.69200 Baruno Adi Christiantoro(1*), Harsono Harsono(2), Cempaka Thusina Srie Setyaningrum(3)
(1) KSM Saraf, RS Panti Rapih, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
Epilepsy is one of the most prevalent noncommunicable neurologic disease. It is estimated to affect almost 70 million people worldwide. Epidemiological data indicate that 20–40% of the patients with newly diagnosed epilepsy will become refractory to treatment. Only 5-10% of this population will be candidate of surgical resection which is a superior therapy in refractory epilepsy.
Repetitive Transcranial Magnetic Stimulation (rTMS) is considered as a future therapeutic method for refractory epilepsy which is non-invasive, relatively safe, and inexpensive. Low frequency rTMS promotes intracortical inhibition. Antiepileptic effects of low frequency rTMS induce long term depression like phenomena by increasing GABAergic inhibition.
Some research suggests that low-frequency rTMS may reduce the frequency of seizures and epileptiform discharges in refractory epilepsy, especially in localized epileptiform zone as in congenital malformation of cortical development. Antiepileptic effect of low frequency rTMS last up 2-4 weeks after treatment. Figure of eight rTMS coil stimulation above epileptogenic area is more effective than other regions. Further clinical studies are needed to determine rTMS protocol patient’s inclusion criteria and assessment of outcomes that provide benefit for patients with refractory epilepsy.
ABSTRAK
Tujuh puluh juta penduduk dunia diperkirakan mengalami epilepsi. Sekitar 30% penderita epilepsi dipertimbangkan mengalami refrakter. Hanya 5-10% dari populasi ini yang dapat menjadi kandidat bedah reseksi yang merupakan terapi superior epilepsi refrakter.
Repetitive TMS dapat dipertimbangkan sebagai salah satu terapi masa depan noninvasif, aman, dan tidak mahal pada pasien epilepsi refrakter. Stimulasi rTMS frekuensi rendah dapat mempromosikan inhibisi intrakortikal. Efek antiepilepsi TMS frekuensi rendah adalah dengan menginduksi long term depression dengan cara meningkatkan inhibisi GABAergik.
Beberapa penelitian menunjukkan rTMS frekuensi rendah dapat mengurangi frekuensi bangkitan dan gelombang epileptiform pada pasien epilepsi refrakter, terutama epilepsi dengan zona epileptiform kortikal terlokalisasi seperti malformasi kongenital pada perkembangan kortikal. Efek antiepilepsi TMS tersebut berlangsung setidaknya 2-4 minggu. Efek rTMS frekuensi rendah lebih bermakna bila stimulasi dilakukan dengan koil bentuk “eight” di atas area epileptogenesis. Studi klinis lebih lanjut diperlukan untuk menentukan protokol rTMS, kriteria inklusi pasien, efek OAE, dan penilaian luaran yang memberikan keuntungan bagi pasien epilepsi refrakter.
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Ngugi AK, Kariuki SM, Bottomley C, Kleinschmidt I, Newton CR. Incidence of epilepsy A systematic review and meta- analysis. Neurology. 2011;77(10):1005–1012. 2. Shorvon SD. The causes of epilepsy : Changing concepts of etiology of epilepsy over the past 150 years. Epilepsia. 2011;52(6):1033–1044. 3. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Hauser WA, Mathern G, et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–1077. 4. Beleza P. Refractory epilepsy: A clinically oriented review. European Neurology. 2009;62(2):65–71. 5. Arroyo S, Brodie MJ, Avanzini G, Baumgartner C, Chiron C, Dulac O, et al. Is refractory epilepsy preventable? Epilepsia. 2002;43(4):437–444. 6. Uijl S, Leijten F, Moons K, Veltman E, Ferrier C, Donselaar C. Epilepsy surgery can help many more adult patients with intractable seizures. Epilepsy Research. 2012;101(3):210–216. 7. Al-otaibi F, Al-khairallah T. Functional neurosurgery : The modulation of neural and mind circuits. Neurosciences. 2012;17(1):16–31. 8. Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. The Lancet Neurology. 2008;7(6):525–537. 9. Otaibi F, Hamani C, Lozano A. Neuromodulation in Epilepsy. Neurosurgery. 2011;69(4):957–979. 10. Robert F. Therapeutic Devices for Epilepsy. Annals of Neurology. 2012;71(2):157–168. 11. Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology. 2009;120(12):2008–2039. 12. Theodore W, Hunter K, Chen R, Vega-Bermudez F, Boroojerdi B, Reeves-Tyer P, et al. Transcranial magnetic stimulation for the treatment of seizures a controlled study. Neurology. 2002;59(4):560–562. 13. Tergau F, Neumann D, Rosenow F, Nitsche MA, Paulus W, Steinhoff B. Chapter 41 Can epilepsies be improved by repetitive transcranial magnetic stimulation? - interim analysis of a controlled study. Supplements to Clinical Neurophysiology. 2003;56(C):400–405. 14. Kwan P, Brodie MJ. Early Identification of Refractory Epilepsy. New England Journal of Medicine. 2000;342(5):314–319. 15. Thut G, Northoff G, Ives JR, Kamitani Y, Pfennig A, Kampmann F, et al. Effects of single-pulse transcranial magnetic stimulation (TMS) on functional brain activity: A combined event-related TMS and evoked potential study. Clinical Neurophysiology. 2003;114(11):2071–2080. 16. Ziemann U. Transcranial magnetic stimulation at the interface with other techniques a powerful tool for studying the human cortex. Neuroscientist. 2011;17(4):368–381. 17. Chen R, Classen J, Gerloff C, Celnik P, Wassermann E, Hallett M, et al. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. 1997;48(5):1398– 1403. 18. Cincotta M, Borgheresi A, Gambetti C, Balestrieri F, Rossi L, Zaccara G, et al. Suprathreshold 0.3 Hz repetitive TMS prolongs the cortical silent period: Potential implications for therapeutic trials in epilepsy. Clinical Neurophysiology. 2003;114(10):1827– 1833. 19. Muellbacher W, Ziemann U, Boroojerdi B, Hallett M. Effects of low-frequency transcranial magnetic stimulation on motor excitability and basic motor behavior. Clinical Neurophysiology. 2000;111(6):1002–1007. 20. Ricceri R, Leanza R, Lentini F, Rampello L, Rampello L. Transcranial magnetic stimulation in vascular cognitive impairment. Acta Medica Mediterranea. 2013;29(1):115–120. 21. Kimiskidis VK, Valentin A, Kälviäinen R. Transcranial magnetic stimulation for the diagnosis and treatment of epilepsy. Current Opinion in Neurology. 2014;27(2):236–241. 22. Rotenberg A. Prospects for clinical applications of transcranial magnetic stimulation and real-time EEG in epilepsy. Brain Topography. 2010;22(4):257–266. 23. Kotova O V, Vorob’eva O V. Evoked motor response thresholds during transcranial magnetic stimulation in patients with symptomatic partial epilepsy. Neuroscience and Behavioral Physiology. 2007;37(9):849–852. 24. Inghilleri M, Mattia D, Berardelli A, Manfredi M. Asymmetry of cortical excitability revealed by transcranial stimulation in a patient with focal motor epilepsy and cortical myoclonus. Electroencephalography and Clinical Neurophysiology. 1998;109(1):70–72. 25. Johnston MV. Developmental aspects of epileptogenesis. Epilepsia. 1996;37(Suppl 1):S2-9. 26. Lowenstein DH. Recent advances related to basic mechanisms of epileptogenesis. Epilepsy research. 1996;11 (Suppl): 45–60. 27. Fregni F, Pascual-Leone A. Technology Insight: Noninvasive brain stimulation in neurology - Perspectives on the therapeutic potential of rTMS and tDCS. Nature Clinical Practice Neurology. 2007;3(7):383–393. 28. Nicoll RA, Schmitz D. Synaptic plasticity at hippocampal mossy fibre synapses. Nature Reviews Neuroscience. 2005;6(11):863– 876. 29. Misawa S, Kuwabara S, Shibuya K, Mamada K, Hattori T. Low- frequency transcranial magnetic stimulation for epilepsia partialis continua due to cortical dysplasia. Journal of the Neurological Sciences. 2005;234(1–2):37–39. 30. Akamatsu N, Fueta Y, Endo Y, Matsunaga K, Uozumi T, Tsuji S. Decreased susceptibility to pentylenetetrazol-induced seizures after low-frequency transcranial magnetic stimulation in rats. Neuroscience Letters. 2001;310(2–3):153–156. 31. Schiller Y, Bankirer Y. Cellular mechanisms underlying antiepileptic effects of low- and high-frequency electrical stimulation in acute epilepsy in neocortical brain slices in vitro. Journal of Neurophysiology. 2007;97(3):1887–1902. 32. Pascual-leone A, Valls-solé J, Wassermann EM, Hallett M. Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain. 1994;117(4):847–858. 33. Wang Y, Zhai Y, Huo X, Zhang J. The effect of low frequency transcranial magnetic stimulation on neuropeptide-Y expression and apoptosis of hippocampus neurons in epilepsy rats. Zhonghua Wai Ke Za Zhi. 2007;45(24):1685–1687. 34. Cantello R, Rossi S, Varrasi C, Ulivelli M, Civardi C, Bartalin S, et al. Slow Repetitive TMS for Drug-resistant Epilepsy : Clinical and EEG Findings of a Placebo-controlled Trial. Epilepsia. 2007;48(2):366–374. 35. Fregni F, Otachi PTM, Do Valle A, Boggio PS, Thut G, Rigonatti SP, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Annals of Neurology. 2006;60(4):447–455. 36. Thut G, Pascual-Leone A. A review of combined TMS-EEG studies to characterize lasting effects of repetitive TMS and assess their usefulness in cognitive and clinical neuroscience. Brain Topography. 2010;22(4):219–232. 37. Kimiskidis, V.K., Kugiumtzis, D., Papagiannopoulos, S., Vlaikidis N. Transcranial Magnetic Stimulation (TMS) Modulates Epileptiform Discharge In Patient with Frontal Lobe Epilepsy : A Preliminary EEG-TMS Study. International Journal of Neural Systems. 2013;23(1):1–16. 38. Kugiumtzis D, Kimiskidis VK. Direct Causal Networks for the Study of Transcranial Magnetic Stimulation Effects on Focal Epileptiform Discharges. International Journal of Neural Systems. 2015;25(5):1–18. 39. Joo, E.Y., Han, S.J., Chung, S.H., Cho, J.W., Seo, D.W., Hong SB. Antiepileptic effects of low-frequency repetitive transcranial magnetic stimulation by different stimulation durations and locations. Clinical Neurophysiology. 2007;118:702–708. 40. Sun, W., Mao, W., Meng, X., Wang, D., Qiao L, Tao W, Li L. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy : A controlled clinical study. Epilepsia. 2012;53(10):1782–1789. 41. Hsu W, Cheng C, Lin M, Shih Y. Antiepileptic effects of low frequency repetitive transcranial magnetic stimulation : A meta- analysis. Epilepsy Research. 2011;96(3):231–240. 42. Bae EH, Theodore WH, Fregni F, Cantello R, Pascual-Leone A, Rotenberg A. An estimate of placebo effect of repetitive transcranial magnetic stimulation in epilepsy. Epilepsy and Behavior. 2011;20(2):355–359. 43. Pascual-Leone A, Houser CM, Reese K, Shotland LI, Grafman J, Sato S, et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalography and Clinical Neurophysiology. 1993;89(2):120–130. 44. Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation. Electroencephalography and Clinical Neurophysiology. 1998;108(1):1–16. 45. Bae EH, Schrader LM, Machii K, Alonso-alonso M, Riviello JJ, Pascual-leone A, et al. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy : a review of the literature. Epilepsy and Behavior. 2007;10:521–528. 46. Pereira LS, Müller VT, da Mota Gomes M, Rotenberg A, Fregni F. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review. Epilepsy and Behavior. 2016;57(Apr):167–176.
DOI: https://doi.org/10.22146/bns.v19i2.69200
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